PA Status Information

Prior authorization (PA) status codes displayed on the Provider
Healthcare Portal (Portal) comply with the Health Insurance
Portability and Accountability Act (HIPAA) 278 transaction
standards and provide only a high-level, standardized description
of the actual working status of the PA request. PA status
information reported through the Interactive Voice Response (IVR)
system is also only a high-level description. PA notification
letters mailed to the provider and member, however, continue to
provide the more detailed administrative working status that more
clearly explains the current status of the PA request.

Table 1 provides a crosswalk between the high-level standard
responses reported on the Portal, on 278 transactions, and through
the IVR with the more detailed administrative working statuses
associated with each standard response. Providers should use this
table to help them understand the standardized HIPAA-compliant
status responses they receive when conducting a PA inquiry.
Providers should refer to their PA notification letters for
additional information regarding the more detailed working status
of a PA request.